Improve Operations by Upgrading Your UC Tools

For the Dayton Veterans Affairs Medical Center, unified communications is akin to a timed-release medication — an investment that keeps paying dividends.

In 2002, the Ohio medical center's outdated LAN was slow; its 15-year-old PBX had reached the end of its life; and its call center couldn't expand to meet growing call volume. The solution? The IT staff built a faster, converged network and installed a Voice over IP system, new call center software and video conferencing equipment. The result? The Dayton VAMC improved its communications, enhanced its patient care and reduced its costs.

Now, nine years later, the 500-bed facility, which provides care to 400,000 patients annually, is still benefiting from the technology and making improvements. The IT team next plans to equip medical staff with tiny wireless devices to speed communications even further. It's also increasing the use of video conferencing, letting patients at outpatient clinics visit with their doctors remotely without having to travel long distances to the medical center.

"One day a surgeon talked about how his patient was in pain and had to take an hour-long shuttle from the outpatient clinic in Columbus, Ohio, to Dayton for a pre-surgery consultation," recalls ­William Frieler, supervisory IT specialist at the Dayton VAMC. "We immediately looked to video conferencing as a way to save our patients from having to take long bus rides to satisfy quality-of-care requirements."

Unified communications — the convergence of software applications and voice, video and data services — is growing in popularity because it improves communication and collaboration, increases worker productivity and cuts IT costs. Today, 14 percent of federal agencies have fully implemented UC, 15 percent are deploying it, and another 36 percent are planning deployments, according to the 2011 CDW•G Unified Communications Tracking Poll, which surveyed 150 federal IT managers.

Many IT organizations take a phased approach to UC. They first install basic core technology, such as VoIP. Then they add tools, such as video conferencing and PC-based communication and collaboration software, and add support for mobile access so employees can retrieve voicemail and e-mail on their smartphones and other mobile devices, says Rich Costello, senior research analyst for IDC. In fact, video conferencing and mobility features are seeing some of the fastest adoption rates in unified communications today, he says.

"The scenario we see a lot is IT organizations with older equipment, older processes and siloed streams of information, and they want to move to new technology," Costello says. "A lot of times, it's a move to Voice over IP first. You build on top of that and start adding other components."

For agencies such as the Dayton VAMC and other Veterans Affairs Department facilities, the Coast Guard and the Holocaust Memorial Museum, unified communications is a work in progress. Some began with VoIP, while others started with video conferencing, but all are continuously fine-tuning and adding new tools and features to their initial deployments to further take advantage of UC's benefits.

Improving Patient Care

When the Dayton VAMC needed to replace its aging PBX, switching to VoIP and UC was an easy decision. For the price of a new PBX, the IT department installed a new network, VoIP system and IP phones for every desk throughout its 33-building campus. It also built a new call center and installed unified messaging — and still had money left over.

"It came under budget of what it normally takes to replace an analog PBX," Frieler says.

In 2002, the Dayton VAMC's IT department augmented its fiber backbone and built a new network with 1 Gigabit Ethernet speeds at the core. This gave the medical center ample bandwidth to handle voice, video and data traffic and also take advantage of next-generation applications, such as digital medical imaging.

Earlier this year, the medical center built an even faster network, upgrading to 10 Gig-E at the core. The 2,000-employee medical center, which first implemented Cisco Call Manager and has since upgraded to Cisco Unified Communications Manager, has reaped the traditional VoIP benefits. It has reduced phone maintenance costs, eliminated telecom carrier and toll charges and improved communication between employees. Unified messaging, which lets staffers check e-mail and voicemail from any device, such as computers or smartphones, speeds up response time, Frieler says.

The IT department continues to add new VoIP features to improve patient care and further enhance communications. Within the next year, if its budget permits, the IT staff hopes to purchase small, wireless, voice-activated VoIP devices that doctors and nurses can clip onto their clothes to quickly find and talk with one another.

"We have a large hospital building, and people are always on the move, so it's hard to track people down," Frieler says. "With this, if you need to get a hold of physicians, you now have the ability."

The IT staff will integrate VoIP — and the wireless devices — with the medical center's nurse call system to improve patient safety. Without the upgrade, only nurses at the nurse's station can see that a patient has pressed his or her call button. With the devices, nurses on the floor will be notified immediately.

"If there's an emergency, the nurse will know right away and can immediately go to the other patient's room," he says.

The Dayton VAMC has also built a new call center using Cisco's IP-based Unified Contact Center Enterprise software, which queues callers and uses interactive voice response technology to distribute calls to the most appropriate nurse or call center agent, reducing wait times and improving customer service.

With a more robust call center, the VAMC not only handles calls for its own patients, but it also has marketed its services to other VA facilities. Today, it manages after-hours support for seven Veterans Integrated Service Networks and runs a national polytrauma call center for veterans returning from Iraq and Afghanistan. Overall, the 24x7 call center handles more than 1 million calls a year.

"With our network infrastructure, we've been able to scale up our call center operation and provide great service," Frieler says.

The medical center uses video conferencing for two reasons: It lets staffers at the main medical center campus and four remote outpatient clinics hold meetings without having to travel. And the Veterans Affairs Department recently made a big push to use video conferencing for clinical support and to allow doctors at main-campus facilities to remotely treat patients at outpatient clinics.

The Dayton VAMC began with Polycom video conferencing equipment, but more recently, it purchased Cisco Tandberg products with 50-inch displays. It owns 25 high-end video conferencing units. It also invested in about 25 desktop units, letting doctors hold video conferences from their desks. In early 2012, the VAMC will deploy one Cisco Telepresence unit at its outpatient clinic in Richmond, Ind., and another at the medical center to study the potential benefits.

Video conferences are used mainly for face-to-face discussions, such as dieticians giving nutrition advice to patients. But more recently, video conferencing equipment paired with special cameras has allowed doctors and specialists to remotely conduct dermatology examinations and review radiology imaging to make diagnoses, Frieler says.

Telepresence uses a lot of bandwidth and is more expensive, but because of its higher resolution, it can help doctors with their diagnoses.

Photo: Keith Lanpher

Unified communications is critical to helping the Coast Guard carry out its missions, Alan Alto says.

"Before, video conferencing was used more for conversations, and now it's moving toward more telehealth and using higher-end equipment," Frieler says.

For Administrative Users

As VA medical centers such as Dayton are increasing their use of telehealth, the department's own administrative offices have also embraced convergence, starting with video conferencing 18 months ago.

Previously, VA had video conferencing systems at 57 administrative offices. About 80 percent of the video conferences used Integrated Services Digital Network connections, and the rest were through IP. Today, the department has increased the availability of video conferencing to 108 locations — all on its IP network.

The video conferencing push has not only improved communications, but it's saving the department money by eliminating ISDN lines and reducing travel by employees, says Horace L. Blackman, CIO and director of VA's Central Office IT Support. "It allows them to more effectively use their time."

In addition, senior executives use video conferencing to interview job applicants, and appeals judges use it to hold hearings and communicate with veterans who are appealing rulings for medical services.

VA is now deploying VoIP and incorporating advanced phone features, such as unified messaging and extension mobility, which lets users go to any IP phone in any VA office, log in with a password and access their work phones.

"This is a tremendous asset in terms of continuity of operations," Blackman says. "If we have to evacuate a building and work from another office, we can sign in through another phone."

The department is also taking advantage of IP television. The IT team makes about 30 channels available so select employees at the VA Central Office can stay current on news. For example, staff members who handle emergency preparedness can watch the Weather Channel to track hurricanes and decide if or when to evacuate VA facilities, ­Blackman says.

From Coast to Coast

Elsewhere, the Coast Guard is embracing multiple UC tools to speed communications and bolster collaboration, which is critical for a military organization whose missions include homeland security, search and rescue, and maritime environmental protection, says Alan Alto, the Coast Guard's enterprise video conferencing service manager.

The Coast Guard first implemented high-end video conferencing in 2003, letting senior leaders in multiple locations hold face-to-face meetings within the agency and with officials from the Defense Department and other agencies.

Two years ago, the agency deployed Microsoft Office Communicator software on every PC so that workers could quickly check their colleagues' online presence and communicate through instant messaging or audio and web conferencing. The Coast Guard's most senior leaders can also use the tool for desktop video conferencing.

This year, the agency began deploying VoIP, including advanced phone features that can route work phone calls to employees' cell phones.

"If an event happens, our senior admirals and operational commanders need to be reached immediately. In the past, we'd have to try their house phones, work phones or cell phones, attempting to communicate," Alto says. "Now we don't have to worry about finding these people. We can let the technology find them."

Moving to the Cloud

Although many agencies are investing heavily in unified communications and building the technology in-house, the U.S. Holocaust Memorial Museum is turning to another option to save money: the cloud.

Museum educators recently piloted a cloud-based web conferencing application, using computer webcams to talk with university students from as far away as Russia to educate them about the Holocaust.

"It's worked quite well, and the video quality is fine," CIO Joseph Kraus says.

The museum owns high-end video conferencing equipment, but its IT staff expects most museum meetings and educational presentations will shift to the cloud application because of the convenience and ease of use. The technology will also reduce travel, which will save money, Kraus says.

Those are the benefits of unified communications in a nutshell: easier communications and reduced costs, points out the Coast Guard's Alto.

"With unified communications, you can more easily find somebody and communicate," he says. "And with the current budget environment, we have mandates to reduce travel, so it does save money."